Membership Commitment Form
	Company ________________________________________________
	Address  ________________________________________________
	City  _____________________  State ________  Zip _____________
	Year Co. Established __________  # of Employees in Region ______
	Mailing Address (if different)________________________________
	________________________________________________________
	City  _____________________  State ________  Zip _____________
	Website _________________________________________________
	Primary Contact __________________________________________
	Title ____________________________________________________
Please Check One Invest. Level Annual Invest.   Founder $30,000   Leader 5,000   Champion 2,500   Visionary 1,000   Advocate 500   Associate 100	Phone ________________________  Fax ______________________
	E-mail __________________________________________________
	Secondary Contact  _______________________________________
	Title ____________________________________________________
	Phone ________________________  Fax ______________________
	E-mail __________________________________________________
	Billing Contact ___________________________________________

We agree to invest $____________ on an annual basis for three years beginning January 1, 2006 through December 31, 2008.

For further information, contact us at 712-433-4493

Monona County Economic Development Partnership for Growth
PO Box 115
Onawa, IA 51040